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Comprehensive chronic care

Rajeshwari Sinha, Sanghamitra Pati
The growing epidemic of noncommunicable diseases (NCDs) has impacted the national health systems, policies, and socioeconomic developments, thereby leading to increasing country level disparities. Despite substantial improvements in health indicators made in the past decade, the Indian health-care system continues to contribute disproportionately to the global disease burden, wherein NCDs holds significant prominence. Against this background, the present review analyzes the current NCD landscape from the perspective of India's health system preparedness toward meeting this growing challenge...
October 2017: Journal of Family Medicine and Primary Care
Emily S Mohn, Hua J Kern, Edward Saltzman, Susan H Mitmesser, Diane L McKay
The long-term use of prescription and over-the-counter drugs can induce subclinical and clinically relevant micronutrient deficiencies, which may develop gradually over months or even years. Given the large number of medications currently available, the number of research studies examining potential drug-nutrient interactions is quite limited. A comprehensive, updated review of the potential drug-nutrient interactions with chronic use of the most often prescribed medications for commonly diagnosed conditions among the general U...
March 20, 2018: Pharmaceutics
María L Pardo Campos, Mariel Musso, Ana Keselman, Laura Gruñeiro, Ignacio Bergadá, Ana Chiesa
INTRODUCTION: Congenital hypothyroidism (CH), as any chronic disease, has an impact on the parent-child relationship and on the child's resources to cope with conflicting situations. OBJECTIVES: To describe parenting styles according to the perception of children with CH and their coping strategies. POPULATION AND METHODS: Children aged 9-10 years who had CH detected by newborn screening and had received adequate treatment and a group without CH (control group)...
April 1, 2018: Archivos Argentinos de Pediatría
Tim Doran
The creation of the National Health Service (NHS) marked a radical break with the past, making health care universally available on the basis of need rather than means. The NHS was conceived during wartime emergency and has had to survive further regular crises to reach its 70th year, but it now faces challenges that are unprecedented in scale and there are doubts about its ability to continue in its present form. Resources have not increased with need, and the NHS can no longer function as a comprehensive service during periods of peak demand...
March 16, 2018: Health Economics, Policy, and Law
E K Yeoh, Martin C S Wong, Eliza L Y Wong, Carrie Yam, C M Poon, Roger Y Chung, Marc Chong, Yuan Fang, Harry H X Wang, Miaoyin Liang, Wilson W L Cheung, Chun Hei Chan, Benny Zee, Andrew J Stewart Coats
BACKGROUND: Chronic Care Model (CCM) has been developed to improve patients' health care by restructuring health systems in a multidimensional manner. This systematic review aims to summarize and analyse programs specifically designed and conducted for the fulfilment of multiple CCM components. We have focused on programs targeting diabetes mellitus, hypertension and cardiovascular disease. METHOD AND RESULTS: This review was based on a comprehensive literature search of articles in the PubMed database that reported clinical outcomes...
May 1, 2018: International Journal of Cardiology
Kamila Premji, Bridget L Ryan, William E Hogg, Walter P Wodchis
OBJECTIVE: To gain a more comprehensive understanding of patients' perceptions of access to their primary care practice and how these relate to patient characteristics. DESIGN: Cross-sectional study. SETTING: Ontario. PARTICIPANTS: Adult primary care patients in Ontario (N = 1698) completing the Quality and Costs of Primary Care (QUALICOPC) Patient Experiences Survey. MAIN OUTCOME MEASURES: Responses to 11 access-related survey items, analyzed both individually and as a Composite Access Score (CAS)...
March 2018: Canadian Family Physician Médecin de Famille Canadien
Wan Kee Kim, Joon Bum Kim
A 58-year-old man visited the emergency department with vague anterior chest discomfort. Based on computed tomographic findings, our initial suspicion was intramural hematoma (IMH) in the ascending aorta. After a comprehensive discussion with relevant departments, emergent operation was planned. Intra-pericardial space, however, was severely adhered suggesting chronic inflammation. Biopsies were performed, and additional surgical procedures were discontinued. The patient was finally diagnosed as having Granulomatosis with Polyangiitis...
March 9, 2018: Annals of Thoracic Surgery
B Josea Kramer, Beth Creekmur, Michael N Mitchell, Debra Saliba
BACKGROUND/OBJECTIVES: Home-based primary care (HBPC) is a comprehensive, interdisciplinary program to meet the medical needs of community-dwelling populations needing long-term care (LTC). The U.S. Department of Veterans Affairs (VA) expanded its HBPC program to underserved rural communities, including American Indian reservations, providing a "natural laboratory" to study change in access to VA LTC benefits and utilization outcomes for rural populations that typically face challenges in accessing LTC medical support...
March 12, 2018: Journal of the American Geriatrics Society
Rachel Bonnema, Megan McNamara, Jennifer Harsh, Elizabeth Hopkins
Chronic pelvic pain in women can arise from many causes and often results in significant declines in function and quality of life. A systematic approach for evaluating patients and initiating a management plan are recommended in the primary care setting. Comprehensive management strategies may include medication, pelvic physical therapy, and behavioral interventions.
March 2018: Cleveland Clinic Journal of Medicine
Julia E Napier, Michael S Lund, Douglas L Armstrong, Denise McAloose
The Amur leopard ( Panthera pardus orientalis) is one of the most critically endangered leopards on the International Union for the Conservation of Nature red list. The primary objective of this retrospective study was to identify common and significant causes of morbidity and mortality in the North American Amur leopard zoo population. This information provides insights that contribute to their improved care, health, and medical management and, ultimately, affects the sustainability of this leopard subspecies in the wild...
March 2018: Journal of Zoo and Wildlife Medicine: Official Publication of the American Association of Zoo Veterinarians
Fernando Rizzello, Ignazio Olivieri, Alessandro Armuzzi, Fabio Ayala, Vincenzo Bettoli, Luca Bianchi, Luca Cimino, Antonio Costanzo, Antonio Cristaudo, Salvatore D'Angelo, Marco Daperno, Anna Chiara Fostini, Mauro Galeazzi, Michele Gilio, Paolo Gionchetti, Paolo Gisondi, Ennio Lubrano, Antonio Marchesoni, Annamaria Offidani, Ambrogio Orlando, Daniela Pugliese, Carlo Salvarani, Raffaele Scarpa, Maurizio Vecchi, Giampiero Girolomoni
INTRODUCTION: Immune-mediated inflammatory diseases (IMIDs) are chronic autoimmune conditions that share common pathophysiologic mechanisms. The optimal management of patients with IMIDs remains challenging because the coexistence of different conditions requires the intervention of several specialists. The aim of this study was to develop a series of statements defining overarching principles that guide the implementation of a multidisciplinary approach for the management of spondyloarthritis (SpA)-related IMIDs including SpA, psoriasis, psoriatic arthritis, Crohn's disease, ulcerative colitis and uveitis...
March 7, 2018: Advances in Therapy
Maria Chiara Corti, Francesco Avossa, Elena Schievano, Pietro Gallina, Eliana Ferroni, Natalia Alba, Matilde Dotto, Cristina Basso, Silvia Tiozzo Netti, Ugo Fedeli, Domenico Mantoan
BACKGROUND: The Italian National Health Service (NHS) provides universal coverage to all citizens, granting primary and hospital care with a copayment system for outpatient and drug services. Financing of Local Health Trusts (LHTs) is based on a capitation system adjusted only for age, gender and area of residence. We applied a risk-adjustment system (Johns Hopkins Adjusted Clinical Groups System, ACG® System) in order to explain health care costs using routinely collected administrative data in the Veneto Region (North-eastern Italy)...
March 4, 2018: European Journal of Internal Medicine
Martin Nagl-Cupal, Julia Hauprich
Children and adolescents with caring responsibilities are an uncontested reality in our society. Most are hidden from public view, and they perform a broad range of caring activities for chronically ill or disabled family members. The research literature has accumulated a comprehensive body of knowledge about young carers' personal needs. However, knowledge and understanding are limited regarding the needs of young carers' families. This knowledge can contribute to preventing children and adolescents from assuming inappropriate caring roles...
March 5, 2018: Health & Social Care in the Community
William B White, Peter Kowey, Ulysses Diva, Mark Sostek, Raj Tummala
BACKGROUND: Naloxegol is a novel selective, peripherally acting μ-opioid receptor antagonist for treating opioid-induced constipation (OIC) in patients with chronic pain syndromes. We analyzed the cardiovascular (CV) safety of naloxegol based on data from its development program prior to approval by the US Food and Drug Administration in 2015. METHODS: Comprehensive CV safety analyses were performed in 4 clinical studies of naloxegol (12.5 and/or 25 mg) in patients with noncancer pain and OIC: two 12-week, double-blind, randomized studies; a 12-week, double-blind, extension study; and a 52-week, randomized, open-label study versus usual care...
January 1, 2018: Journal of Cardiovascular Pharmacology and Therapeutics
Ko Matsudaira, Hiroyuki Oka, Yasushi Oshima, Hirotaka Chikuda, Yuki Taniguchi, Yoshitaka Matsubayashi, Mika Kawaguchi, Emiko Sato, Haruka Murano, Thomas Laurent, Sakae Tanaka, Anne F Mannion
BACKGROUND: The patient-rated Core Outcome Measures Index (COMI) assesses the multidimensional impact of back problems on the sufferer. The brevity and comprehensibility of the tool make it practical for use in clinical and research settings. Although the COMI has been cross-culturally adapted in various languages worldwide, there is currently no Japanese version. The aim of this study was to develop a Japanese version of the COMI by: (1) performing a cross-cultural adaptation of the English version and (2) evaluating the psychometric properties of the Japanese version of the COMI in Japanese volunteers with chronic back problems...
March 2, 2018: BMC Musculoskeletal Disorders
A Vanasse, M Courteau, J-F Ethier
OBJECTIVES: To synthesize concepts and approaches related to the analysis of patterns or processes of care and patient's outcomes into a comprehensive model of care trajectories, focusing on hospital readmissions for patients with chronic ambulatory care sensitive conditions (ACSCs). STUDY DESIGN: Narrative literature review. METHODS: Published studies between January 2000 and November 2017, using the concepts of 'continuity', 'pathway', 'episode', and 'trajectory', and focused on readmissions and chronic ACSCs, were collected in electronic databases...
February 27, 2018: Public Health
Eyal Cohen, Jay G Berry, Lee Sanders, Edward L Schor, Paul H Wise
Discourse about childhood chronic conditions has transitioned in the last decade from focusing primarily on broad groups of children with special health care needs to concentrating in large part on smaller groups of children with medical complexity (CMC). Although a variety of definitions have been applied, the term CMC has most commonly been defined as children and youth with serious chronic conditions, substantial functional limitations, increased health and other service needs, and increased health care costs...
March 2018: Pediatrics
Linda Zhang, Monica Norena, Anne Gadermann, Anita Hubley, Lara Russell, Tim Aubry, Matthew J To, Susan Farrell, Stephen Hwang, Anita Palepu
OBJECTIVE: Individuals who are homeless or vulnerably housed have a higher prevalence of concurrent disorder, defined as having a mental health diagnosis and problematic substance use, compared to the general housed population. The study objective was to investigate the effect of having a concurrent disorder on health care utilization among homeless or vulnerably housed individuals, using longitudinal data from the Health and Housing in Transition Study. METHODS: In 2009, 1190 homeless or vulnerably housed adults were recruited in Ottawa, Toronto and Vancouver, Canada...
March 1, 2018: Journal of Dual Diagnosis
Natalie C Edwards, Michael Munsell, Joseph Menzin, Amy L Phillips
Objective: To assess the trends in the prevalence of comorbidities in US patients with multiple sclerosis (MS), and the association of demographic characteristics with the presence of comorbidities. Study design: A retrospective analysis was conducted from a sample of 5 million patients from the IMS Health Real World Data Adjudicated Claims - US database. Methods: Comorbidity in patients with MS was assessed by year (2006-2014), and logistic regression models evaluated the association of age, sex, and region with select comorbidities...
2018: Patient related Outcome Measures
Ranjith Ambili, Presanthila Janam
Periodontal disease is initiated by microorganisms in dental plaque, and host immunoinflammatory response to the microbial challenge helps in disease progression. Conventional periodontal therapy was mainly targeted on the elimination of microbial component. However, a better understanding of molecular aspects in host response will enable the clinicians to formulate effective host modulation therapy (HMT) for the periodontal management. Inflammatory mediators were the main targets for HMT in the past. Transcription factors can regulate the production of multiple mediators simultaneously, and inhibition of these factors will be more beneficial than blocking individual molecule...
September 2017: Journal of Indian Society of Periodontology
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